Establishing a simple and sustainable quality assurance program and clinical chemistry services in Eritrea.

BACKGROUND: As chronic diseases become more prevalent in developing nations, establishment of sustainable clinical chemistry services will become increasingly important. The complexity of automated instruments, coupled with a lack of resources and skilled workers, will present a challenge for these countries. METHODS: A system emphasizing simplified instrumentation, single source reagents, technical education and support, and simple QC algorithms was established in the small African nation of Eritrea. The same reagents were used on different analyzers, as well as the same lot numbers of QC material. To allow traceability of Eritrea results to an accredited US laboratory, the reagents and QC materials were identical to those used in a large university hospital in the US, and patient samples were frequently exchanged between locations. RESULTS: QC values for 23 clinical chemistry tests in the Eritrean National Health Laboratory compared well to values obtained in the US, showing some statistically different values but no clinically significant differences. QC values were also stable over time in Eritrea. Patient sample values from Eritrea correlated well to values from the US, with r values ranging from 0.71 to 0.99. For 9 chemistry tests, small regional laboratories in Eritrea produced QC and patient values that usually compared well to those from the Eritrea National Health Laboratory, but markedly discrepant values were occasionally observed that prompted investigation. CONCLUSION: A simple but sustainable national laboratory system has been established in the developing nation of Eritrea.

Impact of a multidisciplinary intervention for diabetes in Eritrea.

BACKGROUND: When hemoglobin A1c (HbA1c) testing was made available to diabetic patients in the nation of Eritrea, the majority of values were markedly increased. As a result, a multidisciplinary clinical education program was instituted in Eritrea and the rate of HbA1c testing was increased to monitor progress. METHODS: In February 2003, a cooperative diabetes project was initiated in Eritrea to train diabetes educators, enhance physician education, create patient-teaching materials, and promote glucose monitoring. Two additional visits were made in 2003 and 2004. HbA1c values from January 2003 to November 2004 (n = 3606) were reviewed to assess diabetic control for the population and for a subset of individual patients (n = 350). A cohort of 209 diabetic persons were evaluated for demographics, treatment, and prevalence of complications. RESULTS: The cohort of 209 patients was 34% female and had a mean (SD) age of 50.5 (15.5) years and diabetes duration of 8.6 (6.3) years. Prevalence of hypertension was 37% and proteinuria 6%. For diabetes treatment, 59% received insulin therapy, 35% received oral agents, and 6% received nonpharmacologic treatment. HbA1c values improved significantly between the 1st 6 months of 2003 (median 10.9%) and the last 6 months of 2004 (median 8.5%; P <0.001). Individual patients in whom 2 HbA1c values were measured > or =3 months apart showed a significant mean decrease of 0.5% (P <0.001). CONCLUSIONS: Our experience suggests that the combination of sustainable upgraded laboratory services and training in clinical management leads to sustainable improvement in diabetes care in developing countries.